# The Prevalence and Characteristics of Infective Endocarditis in Liver Transplant Recipients: Insights From National Inpatient Sample Database

## TL;DR

This study finds that infective endocarditis is rare in liver transplant recipients but is linked to worse outcomes like higher mortality and longer hospital stays.

## Contribution

The study provides the first national analysis of IE prevalence and outcomes in liver transplant recipients using a large inpatient database.

## Key findings

- Infective endocarditis occurred in 0.003% of liver transplant recipients.
- Patients with IE had higher in-hospital mortality, ICU admission, and hospital charges.
- Staphylococcus and Enterococcus were the most common pathogens in IE cases.

## Abstract

Liver transplant (LT) recipients are immunocompromised and thus predisposed to various bacterial and fungal infections, including infective endocarditis (IE). The current paper aims to determine the prevalence, characteristics, and outcomes of IE in LT recipients.

The National Inpatient Sample (NIS) data from 2016 to 2020 was used to identify LT recipients. Patients were separated into two groups based on the presence of IE. Information was collected on patient demographics, hospital characteristics, infections, comorbidities, and outcomes. Multivariate logistic regression was performed to assess the impact of IE on outcomes after adjusting for confounding factors.

A total of 170 650 patients who underwent LT were identified using NIS data from 2016 to 2020, of which 0.003% had IE. IE group had higher odds of in‐hospital mortality [aOR 2.2 (95% CI 1.07–4.78)], Shock [aOR 2.7 (95% CI 1.61–4.65)], ICU admission [aOR 2.40 (95% CI 1.4–4.2)], longer Length of Stay [adj. Coeff‐ 3.4 days (95% CI −0.89–5.9, p < 0.008)], and higher hospitalization charges (adj. coeff‐$65271.52, 95% CI $14 825–$115 718) than LT without IE group.

Staphylococcus was present in 18.6% of IE in LT, followed by enterococcus (12.8%) and gram‐negative bacteria (9.8%). Concomitant IE was associated with increased in‐hospital death, ICU stay, and shock. The IE group was also associated with increased LOS and total charges compared to the LT without IE. Although the prevalence of IE is low in LT recipients, its presence portends worse outcomes.

The impact of infective endocarditis in patients with liver transplant needs further inquiry. Analysis of 170 650 patients with LT based on the presence of infective endocarditis was performed. Staphylococcus (18.6%) and Enterococcus (12.8%) were the most common strains identified in patients with IE. Patients with IE had higher odds of in‐hospital mortality, shock, and ICU admission.